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DENT-1440: General and Oral Pathology 1

DENT-1440: GENERAL AND ORAL PATHOLOGY Cuyahoga Community College Viewing: DENT-1440 : General and Oral Pathology Board of Trustees: 2018-01-25

Academic Term: 2018-01-16

Subject Code DENT - Dental Hygiene

Course Number: 1440

Title: General and Oral Pathology

Catalog Description: General principles of pathology including, inflammation, neoplasia, metabolic and endocrine disturbances, and other systemic affecting the general and oral health of the patient.

Credit Hour(s): 2

Lecture Hour(s): 2 Requisites

Prerequisite and Corequisite DENT-1311 Dental Anatomy, Histology & Embryology and DENT-1300 Preventive Oral Health Services I. Outcomes Course Outcome(s): Evaluate the oral manifestations of systemic .

Objective(s): 1. Describe the clinical features and oral manifestations and possible treatment for endocrine and blood disorders. 2. Discuss oral manifestations of oral cancer therapy. 3. Differentiate between primary and secondary immunodeficiencies. 4. Discuss the effects of pharmaceuticals on the oral cavity.

Course Outcome(s): Explain the diagnostic process using common terminology related to pathology.

Objective(s): 1. Use correct terminology to describe intraoral and extraoral lesions. 2. Name a diagnostic category and give an example of a lesion, anomaly or condition for which this category contributes to the diagnosis. 3. Recognize the etiology, typical location, clinical appearance, prevalence, and treatment of variants of normal conditions.

Course Outcome(s): Describe the inflammatory and repair processes and their effects on the body's healing capacity.

Objective(s): 1. Explain the differences between acute and chronic inflammation. 2. Identify the microscopic events of the inflammatory process. 2 DENT-1440: General and Oral Pathology

3. List and describe the three types of tissue repair. 4. Identify the clinical features, etiology and treatment options for injuries to the teeth, oral soft tissues, salivary glands and bone.

Course Outcome(s): Explain the components of the immune response.

Objective(s): 1. Explain the cellular involvement in the immune response. 2. Differentiate between passive and active immunity. 3. Describe autoimmunity and explain how it results in disease. 4. Define immunodeficiency and describe how it results in disease. 5. Distinguish various oral diseases with immunologic pathogenesis including etiology, appearance and treatment. 6. Identify various autoimmune diseases that effect the oral cavity. 7. List examples and uses of medications that can cause immunosuppression.

Course Outcome(s): Identify the factors involved in the development and spread of infectious diseases.

Objective(s): 1. Categorize the etiology of specific infectious diseases as either bacterial, fungal or viral. 2. Explain the mode of transmission, appearance, diagnosis, treatment and prognosis of various infectious diseases.

Course Outcome(s): Distinguish between developmental and inherited disorders.

Objective(s): 1. Classify developmental abnormalities and identify their origin as either soft tissue or structure. 2. Distinguish between developmental odontogenic and developmental nonodotogenic cysts. 3. Describe the various types of dental anomalies.

Course Outcome(s): Compare and contrast genetic abnormalities that affect the head and neck area.

Objective(s): 1. Review normal cell division. 2. Review the molecular composition of chromosomes. 3. Compare and contrast inherited disorders that effect the gingiva and periodontium, jaw bones and facies, and the teeth.

Course Outcome(s): Differentiate between neoplastic and nonneoplastic diseases of the head and neck area.

Objective(s): 1. Differentiate between benign, premalignant and malignant tumors appearing in the oral cavity. 2. Identify risk factors, warning signs, common sites, treatment and prognosis for oral cancer. 3. Identify the clinical & radiographic features, typical locations and treatment for neoplastic and nonneoplastic diseases. 4. Identify nonneoplastic diseases of bone that effect the maxilla and mandible.

Methods of Evaluation: A. Quizzes B. Examinations C. Practical Focus Activities D. Presentations DENT-1440: General and Oral Pathology 3

Course Content Outline: 1. A. Introduction to Oral Pathology a. 1. Common Terminology i. Health ii. Disease iii. Pathology iv. Etiology v. Idiopathic vi. Iatrogenic vii. Predilection viii. Pathogenic ix. Pathonomonic x. Manifestation xi. Signs of disease xii. Symptoms of disease xiii. Lesion xiv. Necrosis xv. Pathogenesis xvi. Sequelae xvii. Prognosis b. Diagnostic process i. Clinical diagnosis ii. Historical diagnosis iii. Radiographic diagnosis iv. Laboratory diagnosis v. Microscopic diagnosis vi. Surgical diagnosis vii. Therapeutic diagnosis viii. Differential diagnosis ix. Definitive diagnosis c. Terms to describe oral lesions i. Macule ii. Patch iii. Erosion iv. Ulcer v. Vesicle vi. Bulla vii. Pustule viii. Wheal ix. Papule x. Nodule xi. Plaque xii. Tumor xiii. Sessile xiv. Pedunculated d. Histologic changes in tissue i. Atrophy ii. Hypertrophy iii. Hypoplasia iv. Hyperplasia e. Variants of normal i. Fordyce granules ii. Torus palatinus iii. Mandibular tori iv. Melanin pigmentation v. Retrocuspid papilla vi. varicosities 4 DENT-1440: General and Oral Pathology

vii. Linea alba viii. ix. Lingual thyroid nodule x. Fissured xi. Median rhomboid xii. xiii. Hairy tongue xiv. Macroglossia xv. Microglossia xvi. Exostoses 2. Inflammation and repair a. Cardinal signs of localized inflammation i. Redness ii. Swelling iii. Pain iv. Loss of noral tissue function b. Cardinal signs of systemic inflammation i. Fever ii. Leukocytosis iii. Elevated C-Reactive Protein iv. Lymphoadenopathy c. Microscopic Events of the Inflammatory Process i. Injury to tissue ii. Constriction of the microcirculation iii. Dilation of the microcirculation iv. Increase in permeability of the microcirculation v. Exudate leaving the microcirculation vi. Increase in blood viscosity in the microcirculation vii. Decrease in blood flow through the microcirculation viii. Margination and pavementing of white blood cells ix. Emigration of white blood cells from the microcirculation x. Phagocytosis by blood cells of foreign substances d. Types of white blood cells i. Neutrophils ii. Macrophages e. Chemical Mediators i. Kinin system ii. Clotting mechanisms iii. Complement system iv. Other biochemical mediators v. Antiinflammatory drugs f. Acute vs. chromic inflammation g. Tissue regeneration and tissue repair h. Microscopic events during repair i. Types of repair i. Primary intention ii. Secondary intention iii. Tertiary intention 3. Injuries to the Teeeth a. b. Abrasion c. d. Erosiion e. Methamphetamine Abuse 4. Injuries to the soft tissue a. Chemical b. Electric c. Thermal DENT-1440: General and Oral Pathology 5

d. Cocaine e. Hematoma f. Traumatic ulcer g. Frictional keratosis h. Linea alba i. Traumatic neuroma j. Nicotine k. Tobacco pouch keratosis l. Smoker''s melanosis m. Amalgam tatoo n. Oral melanotic macule o. Solar p. Petechiae q. Ecchymosis 5. Injuries to salivary glands a. Mucocele b. c. Necrotizing Sialometaplasia d. Sialolith e. f. Xerostomia g. Sjogren''s Syndrome h. Warthin Tumor 6. Reactive Connective Tissue Lesions a. Pyogenic b. Giant Cell Granuloma c. Peripheral Ossifying Fibroma d. Irritation Fibroma e. Fissuratum f. Palatal Pappilomatosis g. Gingival Fibromatosis h. Chronic Hyperplastic Pulpitis 7. Inflammatory Periapical Lesions a. Fistula b. Parulis c. Cellulitis d. Ludwig Angina e. Pulpitis f. Periapical Abscess g. Periapical Granuloma h. i. Condensing Osteitis j. k. Internal and External Resorption 8. Immunity a. Inflammatory vs. immune response b. Components of the immune response i. Antigens ii. Antibodies iii. Lymphocytes iv. Macrophages v. Cytokines c. 3. Types of lymphocytes i. B cells ii. T cells iii. Natural killer cells d. Cell-mediated immune response e. Types of immunity 6 DENT-1440: General and Oral Pathology

i. Active ii. Passive iii. Natural iv. Acquired f. Immunopathology i. Hypersenitivity ii. Autoimmune diseases iii. Immunodeficiency 1. Primary 2. Secondary 9. Oral Diseases with Immunologic Pathogenesis a. Recurrent Apthous Stomatitis b. Hypersensitivity Induced Lesions i. Urticaria ii. Angioedema iii. Contact mucositis iv. Contact dermatitis v. fixed drug eruption vi. Erythema multiforme vii. Reiter''s Syndrome 10. Autoimmune Diseases that Affect the Oral Cavity a. Sjogren''s Syndrome b. Lupus erythematosus c. vulgaris d. Pemphigoid e. Behcet Syndrome 11. Infectious Disease a. Bacterial Infections i. Impetigo ii. Tonsillitis and pharayngitis 1. Scarlet fever 2. Rheumatic fever iii. Tuberculosis iv. Actinomycosis v. Syphilis vi. Mecrotizing ulcerative vii. viii. Acute osteomyelitis ix. Chronic osteomyelitis b. Fungal Infections i. Candidiasis ii. Dee fungal infections c. Viral Infectious i. Human papillomavirus infection 1. Verruca vulgaris 2. Condyloma acuminatum 3. Focal epithelial hyperplasia ii. infections 1. Primary 2. Recurrent iii. Varicella-zoster iv. Epstein-barr v. Coxsackievirus infection 1. 2. Hand-foot-and-mouth disease d. Other Viral Infections with Oral Manifestations i. Measles ii. e. Human Immunodeficiency Virus DENT-1440: General and Oral Pathology 7

i. Progression ii. Oral manifestations 12. Developmental disorders a. Soft tissue abnormalities i. ii. Commisural lip pits iii. Lingual thyroid b. Developmental Cysts i. Dentigerous ii. Eruption iii. Primordial iv. Lateral periodontal v. Calcifying odontogenic vi. Globulomaxillary c. Developmental Nonodotogenic Cysts i. Nasopalatine canal ii. Median palatine iii. Nasolabial iv. Epidermal v. Dermoid vi. Lymphoepithelial vii. Thyroglossal viii. Median mandibular ix. brachial cleft d. Pseudocysts i. Static bone ii. Simple bone iii. Aneurysmal bone 13. Developmental abnormalities of the teeth a. Anomalies that affect the number of teeth i. ii. iii. (supernumerary teeth) b. Anomalies that affect the size of teeth i. ii. c. Anomalies that affect the shape of teeth i. Gemination ii. Fusion iii. Concresence iv. v. vi. Talon vii. viii. Dens in dente ix. x. Supernumerary roots 14. Abnormalities in Tooth Structure a. b. Enamel hypocalcification c. Endogenous staining d. 15. Abnormalities of a. Impacted b. Embedded c. Ankylosed 16. Genetic disorders that affect the oral cavity 8 DENT-1440: General and Oral Pathology

a. Gross chromosomal abnormalities i. Trisomy 21 ii. Trisomy 13 iii. Turner syndrome iv. Klinefelter syndrome v. Cri du Chat and Wolf-Hirschhorn syndrome vi. b. Inherited disorders affecting the gingiva and periodontium i. ii. Papillon-Lefevre syndrome iii. Focal palmoplantar and gingival hyperkeratosis iv. Gingival fibromatosis c. Inherited disorders affecting the jaw bones and facies i. Cherubism ii. Cleidocranial dysplasia iii. Gardner syndrome iv. Basal cell nevus syndrome v. vi. Torus mandibularis vii. Torus palatinus viii. Maxillary exostosis ix. Mandibulofacial dysostosis x. Ellis-van Creveld syndrome xi. Nevoid basal cell carcinoma d. Inherited disorders affecting the oral mucosa i. Cleft palate ii. Cleft lip iii. Hereditary hemorrhagic telangiectasia iv. Multiple endocrine neoplasia v. Neurofibromatosis of von Recklinghausen vi. Peutz-Jeghers syndrome vii. e. Inherited disorders affecting the teeth i. ii. Dentinogenesis imperfecta 1. I 2. II 3. III iii. dysplasia 1. Coronal 2. Radicular iv. Ectodermal dysplasia v. Hypophosphatasia vi. Hypophosphatemic Vitamin D-resistant rickets vii. Peg laterals or congenitally missing laterals viii. Taurodontism 17. Oral cancer a. Description of neoplasia i. Neoplasia ii. Hyperplasia b. Causes of tumors c. Classification of tumors i. Benign ii. Malignant d. Names of tumors e. Treatment of tumors i. Excision ii. Enucleation 18. Premalignant Lesions DENT-1440: General and Oral Pathology 9

a. b. i. Speckled leukoplakia c. Epithelial dysplasia d. Oral submucous fibrosis 19. Tumors of Squamous Epithelium a. Papilloma b. Squamous cell carcinoma c. d. Basal cell carcinoma 20. Salivary gland tumors a. Pleomorphic adenoma b. Monomorphic adenoma c. Adenoid cystic carcinoma d. Mucoepidermoid carcinoma 21. Odontogenic tumors a. b. Calcifying epithelial (Pindborg tumor) c. Adenomatoid odontogenic tumor d. e. Calcifying and cementifying fibromas f. g. Ameloblastic fibroma- h. Odontoma i. Peripheral odontogenic tumor 22. Tumors of Soft Tissue a. Adipose Tissue i. lipoma b. Nerve Tissue i. Neurofibroma ii. Schwannoma iii. Granular cell tumor iv. c. Muscle Tissue i. rhabdomyoma ii. rhabdomyosarcoma d. Vascular Tissue i. hemangioma ii. Lymphangioma iii. Kaposi sarcoma e. Tumors of Melanin-Producing Cells i. Melanocytic nevus ii. Malignant melanoma 23. Tumors of Bone and Cartilage a. Osteoma b. Osteosarcoma c. Chondroma d. Chondrosarcoma 24. Tumors of Blood and Blood-Forming Tissues a. Leukemia b. Lymphoma c. Myltiple Myeloma 25. Metastatic Tumors of the Jaws 26. Nonneoplastic Diseases of Bone a. Benign Fibro-Osseous Lesions i. Periapical cemento-osseous dysplasia ii. Focal cemento-osseous dysplasia iii. Florid cemento-osseous dysplasia b. Types of Fibrous Dysplasia 10 DENT-1440: General and Oral Pathology

i. Monostotic ii. Polystotic c. Paget Disease of the Bone d. Central Giant Cell Granuloma e. Osteomalacia f. Aneurysmal bone cyst 27. Oral Manifestations of Systemic Disease a. Endocrine Disorders i. Pituitary ii. Thyroid iii. Parathyroid iv. Pancreas v. Adrenal b. Blood disorders i. Erythrocytes 1. Iron deficiency anemia 2. Folic acid and vitamin B12 deficiency 3. Pernicious anemia 4. Celiac sprue 5. Thalassemia 6. Sickle cell anemia 7. Aplastic anemia 8. Polycythemia ii. Leukocytes 1. Agranulocytosis 2. Leukemia iii. Thrombocytes iv. Bleeding disorders 1. Hemostasis 2. Platelet count 3. Bleeding time 4. Prothrombin time (INR) 5. Thrombocytopenia purpura 6. Nonthrombocytopena purpura 7. Hemophilia 8. Petechiae 9. Ecchymosis 28. Oral manifestations of therapy for oral cancer a. Radiation b. Chemotherapy 29. Affects of drugs on the oral cavity a. Medication-related

Resources Langlais, R.P., Miller, C.S., J. S. Gehrig. Color Atlas of Common Oral Diseases. 5th. Philadelphia: Wolters Kluwer, 2017.

Eversole, Lewis R. Clinical Outline of Oral Pathology: Diagnosis and Treatment. 4th ed. Shelton: PMPH, USA Ltd., 2011.

Ibsen, O., and J. Phelan. Oral Pathology for the Dental Hygienist. 7th. China: Evolve/Elsevier, 2018.

Neville, B., Damm, D., Allen, C Chi, A. Oral and Maxillofacial Pathology. 4th. China: Elsevier/Saunders, 2016.

Woo, S. Oral Pathology. 2nd. China: Elsevier, 2017.

Odell, E. Cawson's Essentials of Oral Pathology and Oral Medicine, 9th Edition. 9th. China: Elsevier, 2017. DENT-1440: General and Oral Pathology 11

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